Meniscus

The menisci are crescent-shaped fibrocartilaginous structures that fill the spaces between the articular surfaces of the leg bone (tibia) and the thigh bone (femur). There is a meniscus in the inner part (the medial meniscus) and one on the external of the knee (the lateral meniscus). They are important for the stability and functionality of the knee joint and also absorb shocks and reduce wear on the cartilage.

It is one of the most common knee injuries.

When torn, it can partially or totally lock the knee or simply manifest as pain in turning movements or positions with the joint very flexed. Younger people tend to suffer meniscus injury as the result of practicing sports. Older people often have tears due to wear.

It is very important to know how the injury affects daily activity, how much pain it generates and what the expectations are relative to the proposed treatment.

Although having a torn meniscus does not necessarily mean a surgical intervention, it may require different alternatives:

Meniscectomy

involves a resection of the torn meniscal tissue. The aim is to keep as much of the meniscus as possible.

Meniscal repair

Whenever possible, to avoid a decrease in the amount of competent meniscal tissue.

Meniscal substitution

In cases where the patient has pain following a partial meniscal resection. As Dr. Gelber has extensive experience in this technique, he has been called on to share it internationally.

Meniscal transplantation

In cases where the patient has symptoms secondary to a prior resection of the entire meniscus. In these cases, the meniscus comes from a tissue bank.

Lower limb alignment correction (osteotomy). They are usually given in cases where the deviation has a significant impact on the proper functioning of the knee.

Therapy with platelet rich plasma (PRP).Treatment with PRP, widely and mistakenly known as “growth factors”, work to ameliorate the inflammatory component without it having been shown to promote regeneration of damaged tissue. However, it may be indicated when a surgical treatment cannot be done for various reasons.

Stem cell therapy. Biological therapies are one of the challenges of today and tomorrow. They are indicated in specific cases to promote healing. Its use in the treatment of meniscal injuries is not yet widespread.

Upon the need for surgical treatment in any form, the patient is instructed as to care prior to surgery withsimple guidelines.

After surgery

The day after surgery and before leaving for home, the patient receives all the necessary information relative to postoperative care . The patient also leaves the hospital with an appointment for within 10 days or so to have the wound checked and have the stitches removed.

Rehabilitation

Postoperative exercises after meniscus surgery depend on the type of surgery performed on them. In phases and as a general rule, you should not move on to the next until the goal set at the beginning of each phase is reached. However, the precise exercises that can be done ultimately depend on the type of surgery undergone.

First general phase

Control of pain and inflammation

One notices that the knee is sore and swollen the first few days. To improve this, the recommendation is to:

Keep the leg elevated as much as possible.

Apply ice for 15 minutes 4 or 5 times a day.

Take the recommended anti-inflammatory and analgesic drugs.

Use medication prescribed as rescue if there is severe pain

Meniscectomy

Use crutches as needed, depending on pain tolerance.

Motion: no restrictions, increase progressively.

General strengthening exercises.

Progression of all these recommendations gradually to avoid pain that limits recovery.

Meniscal repair

Use two crutches for walking.

Movement: up to 90° between 0-6 weeks, but only in unloaded or non-weightbearing condition. Then gradually increase movement.

Load: between 0-3 weeks, weightbearing is allowed but exclusively with knee fixed in extension with a brace. Between 3-6 weeks, including movement to 90º.

After week 6 as tolerated, progressively.

General strengthening exercises

Progression of all these recommendations gradually to avoid pain that limits recovery

Meniscal substitution or transplantation

Use two crutches for walking.

Motion: up to 90° for between 0-6 weeks. Then gradually increase movement.

Load: no load between 0-3 weeks. Between 3-6 weeks, progressive partial load with movement up to 90°. After week 6 as tolerated, progressively.

General strengthening exercises

Progression of all these recommendations gradually to avoid pain that limits recovery.